Addressing Engagement and Challenging Behaviors within a Naturalistic Language Intervention: A Cross-Disciplinary Collaboration

Background: Delays in communication are a core feature of autism spectrum disorders. Additionally, children with autism frequently display challenging behaviors (CB) that are likely to limit participation in the types of responsive parent-child interactions that facilitate language learning. Speech-language pathologists (SLPs) often have not received the specialized training needed to adequately address CB, potentially limiting the effectiveness of the language interventions they provide. Despite providing complimentary and overlapping services, few research studies have reported on collaborative efforts between Board Certified Behavior Analysts (BCBAs) and SLPs. The current study reports pilot data on cross-disciplinary collaboration from one parent-child dyad enrolled in a parent-mediated language intervention designed to teach mothers naturalistic language-facilitation strategies. 

Objectives: Does collaborative delivery of individualized, direct positive behavior supports (PBS) within the context of SLP coaching sessions result in: (1) increased child engagement in play; (2) decreased CB; (3) increased SLP delivery of language coaching; (4) increased parent use of targeted strategies; and, (5) increased child communication?  

Methods: A 3.6-year-old male child, diagnosed with autism by a university clinic, participated with his biological mother. The child had delays in nonverbal cognition and receptive/expressive language. His CB included head banging, aggression, and tantrums. An SLP implemented the language intervention consisting of 4 clinic-based parent education sessions and 17 one-hour coaching sessions delivered in the home via video-teleconferencing. The manualized intervention incorporated contextually-fitted PBS strategies, as well as indirect consultation by a BCBA. A single-case AB design was implemented comparing distance coaching sessions without and with direct coaching of PBS by a BCBA. Direct PBS was provided for this dyad after nine sessions due to interfering CB and lack of engagement. The PBS was based on a functional analysis, preference assessment, direct observation, and collaboration with the SLP and parent. PBS strategies were embedded within the distance sessions; both the SLP and parent were coached in the use of targeted strategies by the BCBA during ongoing parent-child interaction. Video-clips of all 17 distance sessions were coded using an interval-based metric.

Results: Upon introduction of direct behavior support, CB immediately decreased to 2% of intervals (from an average of 20% at baseline) and remained stable for the remainder of the direct behavior support condition. Simultaneously, child engagement in play increased to 91.7% (from a 30% average at baseline) and SLP language coaching increased to consistently over 30% of intervals (from a 15% average at baseline). During engaged intervals, there was a 71% and 90% increase in frequency of parent prompting of communication acts and responding to child communication acts, respectively, as well as a 125% increase in child spontaneous communication acts. A non-overlap of data index suggested strong effects.  

Conclusions: Collaboration among autism service professionals can result in more effective service delivery. This study provides preliminary evidence for an effective model of collaboration between SLPs and BCBAs. Specifically, decreasing CB allowed the SLP to more effectively implement parent coaching and allowed the mother to engage the child in play, provide language stimulation, and respond to child communication acts by using strategies targeted by the SLP.